STUDENT CONTRACT FOR PERSONAL HEALTH INITIATIVE

 

 Dr. Tauseefullah Akhund M.B.B.S, MPH (Sydney), (Australia)

 Summary

Health promotion and health advancement subject has provided each and every student a golden opportunity to achieve something, for which they have only thought of. As for as I am concerned I grabbed this opportunity with both hands because it provided me opportunity to involve me in healthy activities. With help of this project now I am feeling some kind of discipline in my life as well as in my health status, as I have achieved something that I really wanted. This project was not as simple and easy as I thought, but as it went on I created habit of being part of it. There was some problems faced during project like being consistent initially and commitment to other works, but in the end I can say that with your dedication and commitment to project everything can be achieved.

1.   Introduction

2.   Background and rationale of project

3.   Implementation Plan

4.   Process

5.   Outcomes and evaluation

6.   Discussion

7.   TABLE 1. Selected Health Benefits of Physical Activity

8.   REFERENCES

Summary

Introduction

The main aim of doing this assignment is to select a personal health initiative and work on it in a designed period of time. This project will helps us in thinking about, what sorts of problem we can face during this activity. In this project we will also look for what facilities we have, that might change our personal health behavior and we will also measure changes as a result of this activity. This project gives us understanding of attitudes and behaviors of population towards their health practices by applying our own experiences, so we can understand how difficult or easy to work with them to change or improve their health status. Finally, this project will evaluate, monitor and document the progress of the project.

Background and rationale of project

My personal health initiative for this project is to increase my muscle mass particularly deltoid and biceps (to increase my upper arm circumference), to increase my chest expansion and also to remain fit and healthy. I chose this project because I was not happy with my body it was flabby, non muscular, out of shape and above all I was not stronger as well. I was also bit hypertensive as well and doctor advised me to do regular exercises to reduce some salt in my body, but I was bit reluctant in doing that but this time it was good opportunity for me to do regular exercises to get stronger muscles and also to give shape to my body. My goal during this project is to add at least 1 inch to my upper arm circumference and also to increase my chest expansion by one inch more. Before starting this project I was never satisfied with my whole outfit. I think this project will help me a lot in improving my personal health because after that I will be able to do exercises more regularly. This helps me in long run as well because I will achieve one side advantage of reducing my blood pressure as well. This project will also help me as a public health professional to understand the attitudes of communities towards behavior change.

Implementation Plan

Tasks	Resources required and barriers to overcome	Timeframe	Expected outcomes	Evaluation indicators
Brisk walk Regular gym and home exercise which includes, warming up and then starting with light weight lifting. Heavy weight lifting	Gym membership Weight lifting tools borrowed from friend Watching TV programme on Pakistan TV on dish. Special joggers bought for this project Barriers—-initially I got severe pain in my muscles and whole body because of lifting weight, and overtraining but pain was relieved after some times. Consistency and regularity was sometimes problem, because being international students it was difficult to handle four subject and job and cooking and cleaning at home along with this project	•           Actual time frame for this activity was 12 weeks, so I started this activity with weekly monitoring of any changes in desired outcome

.My daily routine activity was to have a brisk walk about 15 minutes to warm up my body.

.Light and heavy exercise for about one hour daily. .  As this project went on, I was able to improve my stamina of walking and weight lifting.

.More over my chest expansion was much better, and finally I can say that it improved my personality as well because I am now feeling mentally satisfied that I have achieved some thing.

Process

In order to increase your muscle mass you have to force the body to add it and  it is not possible with having a three sets of exercise with irregularity that you have read in any fitness magazine. According Cannone (2004) you have to provide your body a stimulus. This can be done in many ways. Basically, you need to force the body to add muscle by subjecting it to levels of stress it is not used to. Some methods are more obvious than others but all can work.

Here are a few examples of how this can be done effectively:

·         Increase weight or resistance.

·         Perform more repetitions.

·         Perform more sets.

·         Move the resistance slower.

·         Rest less between sets and exercises.

My daily routine was to have a brisk walk initially for fifteen minutes daily just to warm up your self before you start your exercise initially during this project I chose light weight dumbles but as this project went on I added more weight to it and then with more resistance to it and up till now apart from few initial problems that I had mentioned already I am doing fine.

Outcomes and evaluation

Private health insurance in Australia and New Zealand.

 

EFFECTS OR ADVANTAGES OF INCREASED LEVEL OF PHI

According to Quicken (2003) there will be:

• Less waiting time for elective surgeries.
• Facilities like a TV or phone in hospitals can be provided.
• People can afford choose the doctor of there choice.
• Patients can be treated in a private ward.
• Some funds also cover you as a ‘private patient in a public hospital’. This means that you can choose your own doctor, but otherwise the treatment you receive will be same as, if you were a public patient.

Certain types of people may benefit more from private health cover than others like:

• Those who generally remain unhealthy or predisposed to illness should consider private cover.
• People who are starting a new family, because young children have more health problems then adults.
• People, who are involved in hi-risk activity like, jumpers and rock climbers, might feel more comfortable with private cover.
• Age – as age increases there are greater chances that people often become ill.
• People who are playing sports are also at high risk of injury (Quicken, 2003).

PITFALLS/DISADVANTAGE

·        There are certain disadvantages of this system because health insurance is expensive and it will cost a couple without children around $2,500 per annum despite of deduction of 30 per cent government rebate. And for the maximum cover, a couple could expect to pay about $4,170 per annum after the subsidy, or nearly $6,000 without it. This is a definitely a expensive for most people’s household budget, and most people cannot afford it. (Kinna, 2003).

• With this system anyone who regularly claims more than the cost of their contributions is likely to stay with private health insurance. People who pay more than they claim will continue to re-evaluate their membership. If the cost is regularly more than the return, people will opt out   (Kinna, 2003).

·        Under Medicare system only three per cent of the dollar is spent on administration and 97 per cent on health care, where as in private health insurance system 14 per cent goes on administrative costs to check all those claims, and another 25 per cent goes to the shareholders, leaving only around 60 per cent for health care (Cost, 2003).

Private Health Insurance in Other Countries

Pakistan

• In countries like Pakistan private health insurance is working very differently. In Pakistan there is no government funded insurance system as in Australia like Medicare and other private agencies (Makinen, 1993). Government provide only fixed amount of money called as a medical allowance to only those people who are government employee, not to each and everyone.
• This fixed amount is part of there salaries which they get at the end of month, irrespective of whether u get ill or not. This amount is usually small and if any one gets ill unfortunately he has to beer out of pocket expenses.
• According to Makinen (1993) private health insurance industry is working in Pakistan, but differently as compared to Australia. PHI industry provide this facility to private firms and companies and these companies then provide this facility to there employees and cover there all expenses if they get ill, though these companies are only few in number.
• In Pakistan government is not supporting PHI industry like Australia, government don’t offer rebates and other things. Currently people who get private health insurance cover have to pay by him.
• The reason why PHI industry is unable to work efficiently there is because current private health insurance programs are plagued by cost escalation, fraud, and abuse. People often don’t get ill but they charge insurance companies for that, with the help of fake medical certificates.
• For people who are neither government employee nor of private companies has to go government hospitals for seeking medical care, but government doesn’t provide all benefits like medicine and surgical stuff, and patient has to pay this from his pocket above all medical care provided in government hospitals is also not satisfactory.

New Zealand

• In New Zealand private medical insurance was covering only surgical treatment, until the more recent involvement of physician proceduralist like gastroenterologist and cardiologist (Bloom, 2000) Benefits for patients seeking psychiatric and medical care are strictly limited.
• The traditional PHI policy in New Zealand has provided part or a surgeon’s entire fee and the inpatient hospital fees associated with surgery.
• Bloom (2000) states that in mid 1980 PHI in New Zealand covered around 40 percent of the population, but by 1998 it fell to only 25 percent, mostly due to same reasons as in Australia.
• Government in 80s removed tax deductibility on PHI, which resulted in rise in premiums which supported directly to old people with surgical need. This resulted in vicious circle because more health policy holders relinquished there coverage, premiums increased to higher average cost of health care users who remain insured.
• Since 1990 private health insurers in New Zealand have become increasingly aggressive in applying other mechanisms to manage use of health services. Insurers are more keen then there Australian counterparts in applying strategies which are prevalent in USA, such as managed care.
• In 1993 government tried to introduce scheme with establishment of privately managed health plans, with partial payment of insurance premiums by government supplied voucher. This scheme was abandoned, but it is still favored by some conservative politician in New Zealand.

Health expenditure

According to Harper (2003) health is a large component of the Australian economy currently involving well over $40 billion of public and private expenditure (or 8.5% of GDP), around 32% of which is privately funded. The cost to Government of the rebate must be seen in this context and reviewed against the contribution of the Commonwealth to the overall system together with other levels of Government and the private sector.

 

Cost of the rebate

Australian Bureau of statistics (2003) calculated that the gross cost of the Rebate was around $1.384 billion in its first full year of operation (1900- 2000), with a net cost to the budget of $1.084 billion. If the participation rate were to increase to 35% the rebate will cost the Commonwealth a total of $1.486 billion or $1.168 billion net, and cover another 380,000 people. However, this must also be counterbalanced by the relatively cheaper cost to the Commonwealth of private care.

There are savings arising from increased participation through the Australian Health Care Agreements. The Department has estimated that if the participation rate increased to 35% the Commonwealth would save around $155.2 million, partly offset by the impact on the MBS.

Key findings

• If the recent policy measures were not introduced or are reversed in the future, PHI coverage would fall to unprecedented low levels, making it potentially unviable (Wilson, 1999).
• According to deeble (2003) without the 30 per cent rebate and without LHC, hospital coverage is projected to fall to only 18 per cent of the population by 2041-42. The viability of the PHI system would then be in question.
• According to deeble (2003) if the PHI system were to collapse, government budgets would come under enormous pressure. Commonwealth and State Governments together already face a considerable jump in health outlays from 6.4 per cent of Gross Domestic Product (GDP) in 2001-02 to 12.2 per cent in 2041-42. If PHI were to disappear, the jump would be even higher to 12.7 per cent of GDP, representing an additional rise of 0.5 percentage points of GDP. This is because while the government would “save” 0.4 per cent of GDP from the disappearance of the 30 per cent rebate, this would be out weighed by additional health outlays of 0.9 per cent of GDP in areas no longer funded by PHI benefits, especially hospitals.
• So PHI is a main source of funding of health costs. For each 30 per cent rebate dollar spent by government, it saves around two dollars of costs funded by private health insurers (Deeble 2003).
• An important issue to be addressed is whether current PHI policy arrangements will be sufficient to maintain a viable PHI system in the long-term (Wilson, 1999). This depends largely on whether PHI coverage rates will continue to be high enough to maintain a viable system.
•  According to Australian Government Department of Health and Ageing (2001) the rebate recognizes the bond between private health insurance participation, the demand for publicly funded hospital and medical services, and the value of the private sector complementing to the public sector. Each and every fall in the private health insurance coverage, feeds directly through into the public system as more and more people become entirely reliant on the public system for their health care.

 

Critical review of key findings

• Harper (2003) states that the private sector plays a significant role in containing government spending on health and aged care. Each year, private hospitals share the burden of the national case-load with public hospitals. In 2001-02, private hospitals performed medical procedures that would have cost the public hospital system $4.3 billion to undertake. In other words, without the private sector, the cost of public hospital services would have been around one-third higher than they were, i.e., $18 billion rather than $14 billion.

 

• There is a rich debate going on the role and worth of PHI in Australia. Critics have mounted both vigorous attacks on and defenses of this component of Australia’s health care system, with the 30 per cent rebate a particular focus. Deeble (2003) criticized the rebate, claiming it had done little to boost PHI coverage of the population.

 

• On the other side of the debate, Harper (2003) suggested that any collapse of the PHI industry would add to government health outlays, with the saving from the disappearance of the rebate outweighed by increased spending on public hospitals to fill the gap left by the demise of private hospitals.

 

• These arguments have been backed by appeals to salient facts and simple figuring. However, since Australia’s health system is characterized by interdependencies among their various parts, both in terms of their operation and funding, proper illumination of the issues requires a quantitative framework which systematically takes these interdependencies into account.

 

• Deeble6 (2003) explains that, prior to the introduction of the 30 per cent rebate, he conducted a survey gauging people’s buying intentions before the effect of the rebate was in place. Deeble that the 30 per cent rebate would add 4 percentage points to hospital coverage and 5.6 percentage points to ancillary coverage.

 

• To assess whether current PHI policy schemes will be sufficient to maintain a viable PHI system in the long-term or not Schofield (1997) states that many factors influence decisions to take out PHI. These factors include income, gender and age. Age is a significant factor because the expected benefits from having hospital coverage increase with age. Further, according to Wilson (1999) there are some differences in the factors driving hospital and ancillary coverage. Both authors also consider premiums to be an important factor driving PHI coverage.

 

·        It has also been argued by Cost (2003) that the private health insurance rebate is being $2.3 billion but the Health Economics Unit at Monash University has recently analyzed the actual cost of the PHI Rebate. Medicare levy from people taking up private health insurance, it comes to $3.7 billion.

·        Cost (2003) further emphasizes that Medicare is tried and tested model and has always worked as a cost effective model. People do not go directly to expensive specialist care. They go first to their GP who, hopefully keeps them healthy and keeps them away from expensive care unless it is necessary.

·        According to Cost (2003) at the moment you are free to walk into any public casualty centre if you feel sick, you are free to do it. If you see your doctor, he or she is free to treat you, without needing approval from the government or an insurance company.

CONCLUSION

According to Australian Government Department of Health and Ageing (2001). The main reason people were dropping private health insurance is the raising cost of premiums. The introduction of rebate will make private health insurance more easily affordable to both new and existing members and will halt the decline in the participation rate. It will give the industry the chance and will allow them to make the most of recent and proposed structural reforms. According to Wilson (1999) The Government agenda for private health insurance not only involves the rebate, but broad ranging structural changes to allow the industry to offer more attractive products and to become more competitive. The size of the rebate is equal to the financial support removed from the private sector over earlier years and the contribution made by private health insurance to public hospitals. With a considerable rise in funding for public hospitals through the Australian Health Care Agreements, the issue is not one of competing priorities, but complementary initiatives. Health insurance complements Australian system of universal access with around 80% of private patient hospital care coverage through private insurance. It is entirely reasonable for those exercising that choice to retain a substantial part of the funding from the public system, than for the uninsured. According to Australian Government Department of Health and Ageing (2001) there are strong arguments not to means test the rebate, evidences are suggesting that people who are in the middle to higher income bracket that are leaving private health insurance and that these are in fact the people who should be encouraged to retain their insurance to protect the risk pool and hence supporting community rating.

 

RECOMMENDATIONS

• Government can increase the rebate from 30% to 40% if government wants to improve more in private health insurance membership. This will also attract lower income families.
• Government can provide some flexibility in life time health cover for older people because at this time people who get membership after age of 30 have to pay 2% extra premium.
• There are some suggestion from people especially those who are opposing this system according to cost (2003) subsidies to private health insurance has increased the pressure on public hospitals, and that better health outcomes could be achieved by government directly funding private hospitals and bypassing the private health insurance industry.
•  According to cost (2003) utilizing the $2 billion cost of private health insurance rebates directly into private hospitals would be more useful in preventing  unnecessary leakages in the form of administration, ancillaries and gap payments that account for nearly half of the tax subsidy.
• Changes to the reinsurance system that underwrites the community rating principles in the private health insurance sector, to promote efficiency and competition by giving incentives for funds to control utilization rates and unit costs (Australian Government Department of Health and Ageing 2001).
• Changes to allow coverage of total episodes of care including alternatives to hospital care, like hospital in the home services (Australian Government Department of Health and Ageing 2001).
• Changes to allow health funds to offer discounted premiums to groups based on administrative savings in order to develop a wholesale market for private health insurance (Australian Government Department of Health and Ageing 2001).

.

 

REFERENCES

• Australian Government Department of Health and Ageing (2001). The Australian Health Care System: An Outline. Retrieved on 01-10-2004 available at. http://www.health.gov.au/haf/ozhealth/ozhcsyspart1.htm
• Australian Bureau of statistics (2003). Year Book Australia 2003 Health Private health insurance. Retrieved on 02-10-2004 available at.  http://www.abs.gov.au/Ausstats/abs@.nsf/0/c8620ccee76b54a8ca256cae000fc5b1?OpenDocument
• Bloom, A. L. (2000). Health Reform in Australia and New Zealand. Oxford: Oxford University Press
• Cost, C. (2003). Doctors Reform Society of Australia, Politics in the Pub – Private Health Insurance and Medicare. Retrieved on 01-10-2004, available at. http://www.drs.org.au/articles/2003/art14.htm.
• Deeble, J. (2003). The Private Health Insurance Rebate – Report to State and Territory Health Ministers. National Centre for Epidemiology and Population Health.
• Duckett, S. J. (2002). The Australian Health Care System. Oxford: Oxford University Press.

• Gardner, H. (1992).  Health Policy Development, Implementation and Evaluation in Australia. Melbourne: Churchill Livingstone.
• Harper, Ian. (2003). Preserving Choice: A Defence of Public Support for Private Health Care Funding of Australia. Harper Associates.
• Kinna, A. (2003). Private Health Insurance: A Sad History of A System In Crisis. Retrieved on 02-10-2004 available at: http://www.brisinst.org.au/resources/brisbane_institute_kinna_health.html

 

• Makinen, M. (1993). Policy Options for Financing Health Services in Pakistan. Submitted to: U.S. AID Mission to Pakistan and Health Services Division Office of Health Bureau of Research and Development Agency for International Development. Retrieved on 08-10-2004, available at: http://www.phrplus.org/Pubs/tr10v1.pdf
•  
• Private Health Insurance Administration Council (PHIAC), Quarterly Statistics (March 2002). Retrieved on 01-10-2004 available at: http://www.phiac.gov.au/

 

• Quicken (2003), Personal Finance Insurance: Health. Retrieved on 31-09-2004, available at: http://www.quicken.com.au/personalFinance/Insurance/health.aspx

 

• Schofield, D. (1997). Behind the Decline: The Changing Composition of Private Health Insurance in Australia, 1983-95. Discussion Paper No. 17, National Centre for Social and Economic Modeling.

 

• Wilson, J. (1999). An Analysis of Private Health Insurance Membership in Australia. Discussion Paper No. 46, National Centre for Social and Economic Modeling.

 

Tables

 

.29 PERSONS WITH PRIVATE HEALTH INSURANCE, Proportion of total population
	Year ended 30 June						Quarter ended
	1990	1992	1994	1996	1998	2000	June 2001	March 2002
	%	%	%	%	%	%	%	%
With private hospital cover	44.5	41.0	37.2	33.6	30.6	43.0	44.9	44.7
With private ancillary cover	39.9	37.5	34.5	32.9	31.7	39.2	40.5	41.2
Source: Private Health Insurance Administration Council, ‘Quarterly Statistics March 2002’.

 

 

Source PHIAC 2001

 

Source: World Health Report 2000

 

 

 

 

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